Does the predictive value of ST-segment analysis during submaximal exercise testing for diagnosing coronary artery stenosis differ between men and women with chest pain?
Submaximal exercise tolerance testing has a significantly lower positive predictive value for diagnosing significant coronary artery stenosis in women compared to men, highlighting important sex-based differences in diagnostic accuracy.
We evaluated the ability of ST-segment analysis during submaximal exercise tolerance testing (85% predicted age-adjusted heart rate) to diagnose the presence of significant coronary artery stenosis (2 75% cross sectional area narrowing) in a group of 85 men and 92 women with chest pain syndromes and no previously documented myocardial infarctions. Disease prevalence by selective coronary angiography was 36% for men and 33% for women (NS). Predictive value of a positive exercise test (PV(+ET)) as defined by 1 mm ST-segment depression 0.08 second after the J point was significantly higher for men than for women (77% vs 47%, p < 0.05). Predictive value of a negative test (PV(-ET)) was not significantly different for men (81%) and women (78%). Analysis of the 66 men and 66 women not taking digitalis preparations again showed that PV(+ET) was significantly higher for men than for women (90% vs 45%, p < 0.01).
Barolsky et al. (Thu,) studied this question.